11.5 : Acute Pancreatitis II: Clinical Manifestations and Management

Acute pancreatitis presents a complex medical emergency characterized by rapid onset inflammation of the pancreas, demanding timely diagnosis and management to prevent complications. The condition primarily manifests through severe upper abdominal pain that often radiates to the back. This pain intensifies following the consumption of fatty foods. Accompanying symptoms such as nausea, vomiting, abdominal distention, fever, dyspnea, cyanosis, and jaundice can vary in intensity but significantly impact patient well-being.

Diagnostic Criteria

The diagnosis of acute pancreatitis is contingent upon the satisfaction of specific criteria:

1. Patients typically report mild to severe pain in the mid-epigastric region, a primary clinical indicator.
2. Biochemical markers are critical; elevated serum amylase or lipase levels are hallmark features of pancreatic inflammation. When found in high concentrations, these enzymes indicate pancreatic stress or injury.
3. Imaging techniques such as CT scans or ultrasounds visualize the anatomical changes within the pancreas. These may include enlargement, cysts, hemorrhage, and tissue necrosis.
4. MRI may detect finer details, such as parenchymal atrophy and duct dilation, offering further insights into the disease's progression.

Management Strategies

Managing acute pancreatitis involves a multi-faceted approach aimed at alleviating symptoms and preventing serious complications like shock and organ failure.

• Initial treatment usually includes managing the patient in nil per oral (NPO) status to reduce pancreatic stimulation, which helps decrease the production of pancreatic enzymes. Early enteral feeding is also recommended to support nutritional needs without exacerbating the condition.
• Pain management is a critical component, typically addressed with the administration of parenteral opioids and non-steroidal anti-inflammatory drugs (NSAIDs).
• Further intensive care management includes meticulous monitoring and correction of fluid and blood loss to manage hemodynamics and prevent hypovolemic shock.
• Antibiotics are administered prophylactically to prevent or control infections, particularly in cases where necrotic tissue is present, which can be susceptible to bacterial colonization.
• Managing associated metabolic disturbances such as hyperglycemia is vital for overall patient stability.
• In scenarios where gallstones trigger acute pancreatitis, biliary drainage or surgical interventions may be necessary if conservative therapies do not yield sufficient results.

These procedures aim to remove obstructions and restore normal biliary function, addressing the underlying cause of pancreatic inflammation.